Alcohol consumption is at its lowest level since the 1960s, yet major health and social consequences are high. Policy interventions are unpopular, and striking the right balance is complicated, Michael Livingston writes.
The statistics are repeated so often as to be almost meaningless – more than 5,500 deaths in Australia each year are attributed to alcohol consumption, along with more than 150,000 hospital admissions.
Heavy alcohol consumption is involved in a significant proportion of assaults and family violence; it contributes to workplace absenteeism and to more than one-quarter of traffic deaths nationwide. There is a perception that these are intractable problems, that Australia’s drinking culture is inherently problematic and that these harms are inevitable. However, this is clearly not the case.
Alcohol consumption in Australia has varied markedly historically, with per-capita consumption of pure alcohol peaking at around 13 litres in the late 1970s and dropping to a low of less than four litres in the 1930s. At the population level, drinking behaviour varies vastly, based on economic, social and policy factors.
Indeed, Australia is seemingly in the midst of such a change at the moment – per-capita alcohol consumption fell to 9.7 litres in 2014, its lowest point since the early 1960s. Drinking among young people, in particular, has fallen dramatically. The proportion of 14-17-year-olds who report any alcohol consumption has fallen from 67 per cent in 2001 to just 39 per cent in 2013, according to unpublished analyses of the National Drug Strategy Household Survey. The potential drivers of these changes are complex and varied, but they point towards potentially major improvements in public health as these young, light-drinking cohorts age.
Unfortunately, though, alcohol consumption continues to contribute to major health and social problems in Australia. Indeed, there is some evidence that alcohol-related harm even among young people has not declined alongside the sharp falls in consumption. In spite of the growing concerns about methamphetamine, the available evidence suggests that alcohol remains the main drug-related driver of harm. For example, in metropolitan Melbourne in 2013/14, there were more than 12,000 alcohol-related ambulance attendances, compared to around 1,200 attendances related to methamphetamines.
Thus, while the broad trends are promising, alcohol-related harm remains a major challenge in Australia. Much of the public policy response has relied on public persuasion and education campaigns that have limited evidence of effectiveness. There is a vast amount of evidence of what kinds of alcohol policies are effective at reducing harm. Unfortunately, the effective policies are generally unpopular: increases in price, reductions in availability and restrictions on promotions.
This disconnect between effectiveness and popularity makes alcohol policy a particularly challenging arena. The recent implementation of restrictions on late-night trading in Sydney have been stunningly effective as public health measures, with reductions in assaults of between 20 per cent and 45 per cent.
However, the effect of these restrictions on business and on cultural and social practices has led to strong resistance from both industry and the broader public, raising the possibility that they will be weakened or removed. This balancing out of public health against other community values is a complex and political one that requires a broader community agreement.
These questions are made more complex against a backdrop of declining consumption – are restrictions required when drinking is dropping anyway? For example, some have argued that restrictions in Sydney were unnecessary given that assaults were already declining. From a public health perspective, it’s hard to argue with the additional drop in violence, but we do need to think about what our endgame looks like. How many alcohol-related deaths are acceptable? How many assaults? How do we weigh up restrictions or policies that negatively affect many people while reducing injuries and deaths among a smaller group?
As it stands, the harm rates remain so high that it’s hard to argue against the need for policy intervention to reduce the large numbers of deaths, injuries and illness associated with alcohol consumption in Australia. However, the dramatic recent declines in youth consumption and the ongoing political and social debates about the balance between public health and public liberty makes the alcohol policy space as complex as it’s ever been.